01 September 2008

One of the top doctors in London (a very persuasive man with a rather common name) tells his audiences how if you travel from Fulham on the tube in an easterly direction life expectancy plummets by the mile. People live much longer in Fulham than they do in parts of the East End. He will then go on to say that this is all to do with the health service and that we need polyclinics to sort out the poor delivery of healthcare to the deprived. Not, of course, that it is deprived patients that the likes of Virgin would want to target but that's another story. Of course it is utter nonsense that deficiencies in the NHS have much to do with these differences in mortality. In Glasgow's Calton area average life expectancy is 54 compared with 82 in Lenzie just eight miles away. That's a 28 year difference. It is a remarkable difference. It is far too remarkable to have much to do with doctors or the provision of health care. Politicians might just be naive enough to think it is the poor local GPs who are responsible for the differences. It's unlikely that the top London doctor who peddles this ludicrous tale believes it. Most probably he has an agenda. Dr Grumble is not taken in.

Any sensible doctor must know that such differences in mortality have more to do with social factors and people. Some people listen to the doctor and religiously do what they are told. That probably helps. But it is not even just that. There is good evidence that if you hand out dummy pills patients who take them according to the instructions do better than those who do not. That may surprise you. It does not surprise Dr Grumble. While he cannot prove it Dr G thinks that those who take pills properly also look after themselves properly in other ways.

In large cities rich areas can be remarkably close to poor areas. The people in rich areas behave very differently from those in poor areas. Some might say that you don't eat well if you cannot afford to. And your housing will be worse. But it seems you are also more likely to smoke even though smoking costs rather a lot and poor people really could do with the money. And staying slim by eating less doesn't cost you anything. You save money. Exercise too can be cheap.

Mrs Grumble had a practice which spanned rich and poor areas. A neighbouring practice set inside a council estate had even more deprived patients. Mrs G used to visit it. On one occasion she also visited the practice loo and was surprised to find the loo seat firmly chained to the wall. She asked why. It was to prevent the loo seat being stolen. Less than a couple of miles away in a rather better part of town such measures were just not necessary. People who steal loo seats are not likely to look after their health. They still have access to doctors (the doctors in the deprived area were excellent and highly motivated) but they will be less likely to listen to them and look after themselves. Their bodies are more likely to be subjected to the assaults of tobacco, drugs, excessive alcohol, couch potatoism and junk food to name but a few. Incidentally the extremely rich are also at risk. They tend to indulge in rich pastimes which can be highly dangerous. Richard Branson is a good example. So far has got away with it. But enough don't for it to show up in the statistics. That's why life insurance costs more for the extremely rich.

Dr Grumble has always thought that the story of the chained up loo seat was a little odd. But apparently the problem of loo seats being stolen by patients is not just a UK problem. Those who speak German will see that they have similar troubles over there.

In case you're wondering, Klo is the German for loo and Deckel means cover making Klodeckel a compound noun meaning toilet lid.